this info may be useful for people who dont respond to some meds, especially antidepressants, must admit I hadnt heard of it earlier recovered former longtime anxiety and panic attack sufferer and helper of other sufferers but no training or qualifications in medicine or psychology, any remarks that may be taken as advice must be confirmed with doctor or other health professional

emails are welcome but do mention healingwell to avoid risk of deletion as spam

thanks for posting this. This is something I have tried to bring to peoples attention, but not too many seem interested. I've posted it here on Healingwell on the depression board and a few other places.

Here is some of what I have posted in the past:

CYP2D6 (cytochrome P450 2D6) acts on one-fourth of all prescription drugs, including the selective serotonin reuptake inhibitors (SSRI), tricylic antidepressants (TCA), betablockers, opiates, neuroleptics, antiarrhythmics and a variety of toxic plant substances. Some 7- 14% of the population has a slow acting form of this enzyme and 7% a super-fast acting form. Thirty-five percent are carriers of a non-functional 2D6 allele, especially elevating the risk of adverse drug reactions when these individuals are taking multiple drugs. Drugs that CYP2D6 metabolizes include Prozac, Zoloft, Paxil, Effexor, hydrocodone , amitriptyline, Claritin, cyclobenzaprine, Haldol, metoprolol, Rythmol, Tagamet, tamoxifen, and the over-the-counter diphenylhydramine drugs, Allegra, Dytuss, and Tusstat. CYP2D6 is responsible for activating the pro-drugs codeine and other opioids into their active forms. The analgesic activity of the drugs is therefore reduced or absent in CYP2D6 poor metabolizers. Refer to list for substrates, inhibitors and inducers of CYP2D6.

Genelex offers improved detection rates using an extended Cytochrome P-450 2D6 DNA mutation panel. This test identifies 12 small nucleotide variants and two gene rearrangements in PCR-multiplex format, providing increased sensitivity and quality performance. This CYP2D6 Mutation Detection Panel is the most extensive on the market and covers over 93-97% of poor metabolizer phenotypes. Analytical specificity and sensitivity for detection of these mutations are >99%.

I think most drs, especially if they are a pdoc know about this problem, they just don't want to do the testing needed as it is expensive, and would be too time consuming to test everyone.

They'd just rather we spend the money and time trying to find a drug that works for us! Just kiddin', I don't know that, it just sometimes feels like that! We brought this to my hubby's pdocs attention, since he is currently up to 900 mgs of Effexor XR, which, in a normal person, would probably kill them. He was aware of this metabolism problem. Didn't seem to think there was anything that could be done, and since Effexor has worked the best on him, to stick with it! He's even drinking grapefruit juice with it in hopes it will enhance the effects of the med!

Only my hubby! The main side effects he has are profuse sweating, constipation and some sexual difficulties, but says they are nothing as long as he can feel "normal". To bad it isn't consistant yet.

Kinda ruffles your feathers to know there are people with this issue, and docs won't always look for it. People don't usually take those medications without a serious need, and to let it go when they don't work is just sad.

I'm not procrastinating----I'm still doing yesterday!!!!

I have no medical training, any medical opinions expressed in my posts are just that....opinions.